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Permit (104) CITY OF TIGARD MASTER PERMIT r , III '� t ,. B COMMUNITY DEVELOPMENTlir /7 Permit#: MST2016 00433 Date Issued: 01/30/2017 T[.G.,, f.?t) 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S 104AC 15100 Jurisdiction: Tigard Site address: 12863 SW 133RD AVE Subdivision: WALNUT RIDGE Lot: 5 Project: Walnut Ridge, Lot 5 Project Description: New SF. 2/21/17, REPRINTED to remove(1) hose bib&(1)laundry tray. 3/29/17, REPRINTED to add 4th bath details to permit. BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 5 First: 1367 sf Basement: 0 sf Left 5 Parking Spaces: 0 Height: 26 Bathrooms: 4 Second: 1533 sf Garage: 491 sf Front: 20 Smoke Dwelling Units: 1 Third: 0 sf Right: 5 Detectors: Yes Total: 2900 sf Value: $349,602.73 Rear: 15 PLUMBING Sinks: 1 Water Closets: 4 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 1 Urinals: 0 Lavatories: 5 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Storm Sewer: 100 Drains: 0 Tubs/Showers: 5 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Catch Basins: 0 Bckflw Prevntr: 0 Footing Drain: 0 Ice Maker: 1 Hose Bib: 1 Backwater Value: 1 Other Fixtures: 0 Drywell-Trench Drain: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 5 Clothes Dryers: 1 Natural Gas Heat Pump: N Hoods: 1 Other Units: 0 Furn<100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 4 Furn>=100K: 0 ELECTRICAL Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits 1000 sf or less: 1 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0 Ea add'500 sf: 5 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 0 Mfd Home/Feeder/Svc: 0 401-600 amp: 0 401-600 amp: 0 601-1000 amp: 0 601+amp-1000v: 0 1000+amp/volt: 0 ELECTRICAL-RESTRICTED ENERGY SF Residential Audio&Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All Other: N Other Description: Ecompasing: Y BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: NEW SF VB R-3 2900 Owner: Contractor: RIVERSIDE HOMES LLC RIVERSIDE HOMES LLC Required Items and Reports(Conditions) 17933 NW EVERGREEN PKWY, 17933 NW EVERGREEN PKWY 370 1 Ersn Cntrl 503-639-4175 #370 BEAVERTON,OR 97006 BEAVERTON,OR 97006 PHONE: PHONE: 503-645-0986 FAX: 503-690-2942 Total Fees: $30,871.97 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTII. a -•on law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-00 rough OAR 2-001-0090. Yo a obtain a copy of/the,rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. ,....) Issue. By: -( �f Permittee Signature: 41--1:- Call 503.639.4175 by 7:00 a.m.for the next available inspection d This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. CITY OF TIGARD ' MASTER PERMIT ' •• ' COMMUNITY DEVELOPMENT �a/ Permit MST2016-00433 13125 SW Hall Blvd.,Ti Date Issued: 01/30/2017 TEL fC;,�I<. Iand OR 97223 503.718.2439.7 9 Parcel: 2S 104AC 15100 Jurisdiction: Tigard Site address: 12863 SW 133RD AVE Subdivision: WALNUT RIDGE Lot: 5 Project: Walnut Ridge, Lot 5 Project Description: New SF. 2/21/17, REPRINTED to remove(1)hose bib&(1)laundry tray. BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 5 First: 1367 sf Basement: 0 sf Left: 5 Parking Spaces: 0 Height: 26 Bathrooms: 3 Second: 1533 sf Garage: 491 sf Front: 20 Smoke Dwelling Units: 1 Third: 0 sf Right: 5 Detectors: Yes Total: 2900 sf Value: $349,602.73 Rear: 15 PLUMBING Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 1 Urinals: 0 Lavatories: 4 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Storm Sewer 100 Tubs/Showers: 4 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Drains: 0 Catch Basins: 0 Bcktlw Prevntr: 0 Footing Drain: 0 Ice Maker: 1 Hose Bib: 1 Backwater Value: 1 Drywell-Trench Drain: 0 Other Fixtures: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 5 Clothes Dryers: 1 Natural Gas Heat Pump: N Hoods: 1 Other Units: 0 Furn<100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 4 Furn>=100K: 0 ELECTRICAL Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits 1000 sf or less: 1 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0 Ea add'l 500 sf: 5 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 0 Mfd Home/Feeder/Svc: 0 401-600 amp: 0 401-600 amp: 0 601-1000 amp: 0 601+amp-1000v: 0 1000+amp/volt: 0 ELECTRICAL-RESTRICTED ENERGY SF Residential Audio&Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All Other: N Other Description: Ecompasing: Y BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: NEW SF VB R-3 2900 Owner: Contractor: RIVERSIDE HOMES LLC RIVERSIDE HOMES LLC Required Items and Reports(Conditions) 17933 NW EVERGREEN PKWY, 17933 NW EVERGREEN PKWY 370 1 Ersn Cntrl 503-639-4175 #370 BEAVERTON,OR 97006 BEAVERTON,OR 97006 PHONE: PHONE: 503-645-0986 FAX: 503-690-2942 Total Fees: $30,871.97 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTEN •'• Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-88 0 through I'R 952-0 1-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issue. By: A / C,°/U✓( /,,, Permittee Signat / �.. / `/LIZ Call 503.639.4175 by 7:00 a.m.for the next available inspection d. ii This permit card shall be kept in a conspicuous place on the job site until , pletion of the project. Approved plans are required on the job site at the time of each inspection. MASTER PERMIT 11111 CITY OF TIGARD a COMMUNITY DEVELOPMENT Permit#: MST2016-00433 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/30/2017 Parcel: 2S104AC15100 Jurisdiction: Tigard Site address: 12863 SW 133RD AVE Subdivision: WALNUT RIDGE Lot: 5 Project: Walnut Ridge, Lot 5 Project Description: New SF. BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 5 First: 1367 sf Basement: 0 sf Left: 5 Parking Spaces: 0 Height: 26 Bathrooms: 3 Second: 1533 sf Garage: 491 sf Front: 20 Smoke Dwelling Units: 1 Third: 0 sf Yes Right 5 Detectors: Total: 2900 sf Value: $349,602.73 Rear: 15 PLUMBING Sinks: 1 Water Closets: 3 Washing Mach: 1 LaundryTrays: 1 Y Rain Drain: 1 Urinals: 0 Lavatories: 4 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain 0 Storm Sewer 100 Tubs/Showers: 4 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Drains: Bckflw Prevntr: 0 Catch Basins: 0 Footing Drain: 0 Ice Maker: 1 Hose Bib: 2 Backwater Value: 1 Drywell-Trench Drain: 0 Other Fixtures: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 5 Clothes Dryers: 1 Natural Gas Heat Pump: N P Hoods: 1 Other Units: 0 Furn<100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 4 Furn>=100K: 0 ELECTRICAL Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits 1000 sf or less: 1 0-200 amp: 0 0-200 amp:00 W/Svc or Fdr: 0 Ea addl 500 sf: 5 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 0 Mfd Home/Feeder/Svc: 0 401-600 amp: 0 401-600 amp: 0 601-1000 amp: 0 601+amp-1000v: 0 1000+amp/volt: 0 ELECTRICAL-RESTRICTED ENERGY SF Residential Audio&Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Y Garage Opener: N All Other: N Other Description: Ecompasing: Y BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy G NEW P yrou Group: Square Feet: SF VB R-3 2900 Owner: Contractor: RIVERSIDE HOMES LLC RIVERSIDE HOMES LLC Required Items and Reports(Conditions) 17933 NW EVERGREEN PKWY, 17933 NW EVERGREEN PKWY 370 1 Ersn Cntrl 503-639-4175 #370 BEAVERTON,OR 97006 BEAVERTON,OR 97006 PHONE: PHONE: 503-645-0986 FAX: 503-690-2942 Total Fees: $30,871.97 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notificationr. Those rules ar- set forth in OAR 952-001-0010 through OAR 952-001-0090. You ma or .in a copy f, •-rules or direct questions to OUNC by calling 503. 87 or 1.800.3 .44 - Issued By' • _ - Permittee Signature: ..*�-.»P) '" •39.4175 by 7:00 a.m.for the next available inspectio da . ./4 This permit card shall be kept in a conspicuous place on the job site until completion of the proj-ct. Approved plans are required on the job site at the time of each inspection. Building Permit Application Zetidential FOR OFF I( F. I S1:ONI.l • Received Permit No.: 47tX it j'001:13, City of Tigard �a[e/By: 1(7/�-v/`c l/I'(! 11111 'll 13125 SW Hall Blvd.,Tigard,OR 97223 , ,L Elf= ) �, )/ 1 Other Permit:.5„)/...4.,Q>11,0_0)� j a Phone: 503.718.2439 Fax: 503.598.1960 Date/By: / ..)..-7 ,1 lr " Date Ready/By: Jens: See Page 2 for Tit_ R Inspection Line: 503.639.4175 Notified Method:(I/�//fit 77 f Supplemental Information Internet: www hgard or.gov 2 2016 ►;f 1 1 .>n Permit fees*are based on the value of the work performed. ►Z/ New construction ❑ ITt II ki .1 V I L Indicate the value(rounded to the nearest dollar)of all ❑Addition/alteration/replacement 0 Other: „, equipment,materials,labor,overhead,and the profit for the work indicated on this application. '' 4 4 i. s , "t. gt.. C) J ‘0 L Valuation: $ ®1-'and 2-family dwelling 0 Commercial/industrial Number of bedrooms: 5 ❑Accessory building 0 Multi-family22 Number of bathrooms: ' J qt. ❑Master builder 0 Other: r l �, 4 tt ► � -t : , Total number of floors: 2 New dwelling area: square feet Job site address:12863 SW 133rd Ave �r� City/State/ZIP:Tigard,OR 97223 Garage/carport area: X491 square feet 1 S4i Suite/bldg./apt.no.: I Project name:Walnut Ridge Covered porch area: 445 square feet i 3a. c:jV-ii '1 ` .41 square feet Cross street/directions to job site:SW Walnut and SW 133rd Ave �. v /'�„ Other structbre area: square feet Subdivision:Walnut Ridge I Lot no.:005 Permit fees*are based on the value of the work performed. Indicate the value(rounded to the nearest dollar)of all Tax map/parcel no.: equipment,materials,labor,overhead,and the profit for the f , t ; work indicated on this application ; _fi , ':, m.�, Valuation: $ Construction of SFR Home Existing building area: square feet New building area: square feet e��. ,` Number of stories: Name:Riverside Homes,LLC Type of construction: Address:17933 NW Evergreen Parkway,Suite 370 Occupancy groups: City/State/ZIP:Beaverton,OR 97006 Existing: Phone:(503)645-0986 Fax ( " ,�> hF 4 4 l d ..,,i.,,e4,-4.- 1 ;3 Business name:Same as Above Structural plan review fee(or deposit): Contact name:Wes Boisvert FLS plan review fee(if applicable): Address: Total fees due upon application: City/State/ZIP: Amount received: Phone:( ) I Fax::( ) i . .. ► ... F.„:—.**# ' E-mail wboisvert@riversidehome.com Commercial and residential prescriptive installation of �.k �� a w �� '. n w , , roof-top mounted Photovoltaic Solar Panel System. :n � � Submit two(2)sets of roof plan with connection details Business name:Riverside Homes,LLC and fire department access,along with the 2010 Oregon Address:17933 NW Evergreen Parkway,Suite 370 Solar Installation Specialty Code checklist. Permit Fee(includes plan review $180.00 City/State/ZIP:Beaverton,OR 97006 and administrative fees): Phone:(503)645-0986 I Fax:( ) State surcharge(12%of permit fee): $21.60 CCB lic.:189148 1 Total fee due upon application: $201.60 / This permit application expires if a permit is not obtained Authorized signature: 'r�� '1 A i.4.) !1� l within 180 days after it has been accepted as complete. I *Fee methodology set by Tri-County Building Industry IPrint name.Wv.Doi.voi t” I D. e:0 /12/2016 Service Board. I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB) Mechanical Permit Application FOR OFFICE U:SE ONE) City of Tigard Date/By:Received - Permit No.: • ! a- ]r II 4 13125 SW Hall Blvd.,Tigard,OR 97223 r 7 lr g !TS Plan Review = Phone: 503.718.2439 Fax: 503.598.196 Other Permit: s ,:,) - _ _4 :' Date/By: T I G A R D Inspection Line: 503.639.4175 Date Ready/By: Juris: ® See Page 2 for Internet: www.tigard-or.gov Notified/Method: Supplemental Information OCT 2 0 101E TYPE OF WORK COMMERCIAL FEE* SCHEDULE —USE CHECKLIST ( iIy Mechanical permit fees*are based on the value of the work few construction 0 Addition/alteraf}inn la �yperformed.Indicate the value(rounded to the nearest dollar)of all ❑Demolition 0 Other: BUILDING DIVISION mechanical materials,equipment,labor,overhead,and profit. Value:$ CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES* 151, -and 2-family dwelling 0 Commercial/industrial 0 Accessory building For special information use checklist. ❑Multi-family 0 Master builder 0 Other: Description Qty. Ea. Total Heating/cooling: JOB;,SITE INFORMATION AND LOCATION r Air conditioning 46.75 Job site address: \1 � '5 t--1;2) 9� \)G Furnace 100,000 BTU(ducts/vents) 46.75 City/State/ZIP: T i 5(�r � D,� (��1-,-1-- Furnace 100,000+BTU(ducts/vents) 54.91 1 Heat pump 61.06 Suite/bldg./apt.no.: Project name: \ tt\' �,t.\4- ( (ati` Duct work 23.32 Cross street/directions to job site: ' \jJ� ' y,\1/ e -')t l Hydronic hot water system 23.32 \ {{ Residential boiler(radiator or 'IN) i,-'1,1) /4\ �l', hydronic) 23.32 Unit heaters(fuel-type,not electric), in-wall,in-duct,suspended,etc. 46.75 r Flue/vent for any of above 23.32 a Subdivision: lt\l ,..\:`\ Lot no.: Other: 23.32 �� '� Other fuel appliances: Tax map/parcel no.: Water heater 23.32 DESC PTIOOF WO Gas fireplace/insert 33.39 ��" Flue vent for water heater or gas n Z 0t.3 C.V- c.) N 1 ^Y'gni, '� fireplace 23.32 ''C Log lighter(gas) 23.32 Wood/pellet stove 33.39 Wood fireplace/insert 23.32 Chimney/liner/flue/vent 23.32 Other: 23.32 tit7 , -OPERTY OWNER 0 TENANT Li i Environmental exhaust and ventilation: Name: \ V Cfr. LI L� I fJ .( Range hood/other kitchen 666 _ -)........r.‘equipment 33.39 Address: ,��'i!, �� J ;,.). 1 v-41 lothes dryer exhaust 33.39 City/State/ZIP: clyl, i.L,y)'.-. r " c I--)'QD l Single-duct exhaust(bathrooms, toilet compartments,utility rooms) 23.32 Phone: (� `)) (�,LI C 0C)t/t Fax:( ) Attic/crawlspace fans 23.32 ok APPLICANT'' ❑ CONTACT PERSON Other: 23.32 Fuel piping: Business name: ��ice, 0,k-, esj21 A" $14.15 for first four;$4.03 for each additional Contact name: Furnace,etc. Address: Gas heat pump Wall/suspended/unit heater City/State/ZIP: Water heater Fireplace Phone:( ) Fax::( ) Range E-mail: Barbecue oi CONTRACTOR Clothes dryer(gas) � ^ \ t COi t-4. Other: Business name: ��QG , e' QV 't" MECHANICAL PERMIT FEES* Address: Subtotal City/State/ZIP: Minimum permit fee($90.00) Plan review(25%of permit fee) Phone:( ) Fax:( ) State surcharge(12%of permit fee) CCB lie.: TOTAL PERMIT FEE „,n This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Authorized signature: * Fee methodology set by Tri-County Building Industry Service Board Print name: Date: I.\Building\Permits\MEC_PermitApp_040113.doc 440-4617T(11/02/COM/WEB) Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial& Multi-Family Fee Schedule: Total`Valuation: Permit Fee: $0.00 to$500.00 Minimum fee$69.06 $500.01 to$5,000.00 $69.06 for the first$500.00 and $3.07 for each additional$100.00 or fraction thereof,to and including $5,000.00. $5,000.01 to$10,000.00 $207.21 for the first$5,000.00 and $2.81 for each additional$100.00 or fraction thereof,to and including $10,000.00. $10,000.01 to$50,000.00 $347.71 for the first$10,000.00 and $2.54 for each additional$100.00 or fraction thereof,to and including $50,000.00. $50,000.01 to$100,000.00 $1,363.71 for the first$50,000.00 and $2.49 for each additional$100.00 or fraction thereof,to and including $100,000.00. $100,000.01 and up $2,608.71 for the first$100,000.00 and $2.92 for each additional$100.00 or fraction thereof. Note: All new commercial buildings require 2 sets of plans. I:\Building\Permits\MEC_PermitApp_040113.doc 2 Electrical Permit Application � �, FOR OFFICI l SI oyl.l City g >aceived ofTigard /. } Plan : Permit#: V • �� [� '1 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review • 1114 • Phone: 503.718.2439 Fax: 503.598.1960 OCT2 r�q Date/B : Related Permit#: Inspection Line: 503.639.4175 i 0 2015 15 Ready Date/By: Jur s: ® See Page 2 for T I G A R 1) Internet: www.tigard-or.gov r i q Notified/Method: Supplemental Information TYPE OF WORICITY O I IGAR PLAN REVIEW '_1 New construction ❑Addition/alterat tit n g Please check all that apply(submit 2 sets of plans w/items checked): r" srl 0 Service or feeder 400 amps or more 0 Building over three stories. • Demolition ❑Other: where the available fault current 0 Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings. . 1-and 2-family dwelling ❑Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural amps for all other installations. buildings. ❑Multi-family 0 Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or JOB SITE INFORMATION AND LOCATION 1 0 Emergency system. larger separately derived Job#: Job site address: \.1., - i\'./ `�i'i� 0 Addition of new motor load of system. tQ `�J �: 100HP or more. ❑ City/State/ZIP: y. 0 0 Six or more residential units. occupancy. ty ` i f W '' ❑Health-care facilities. ❑Recreational vehicle parks. Suite/bldg./apt.#: Project name: fr\ ❑Hazardous locations. 0 Supply voltage for more than t ' J �� ❑Service or feeder 600 amps or more. 600 volts nominal. Cross street/directions to job site: �,'L.� W 1\1. yl,tti,4 c> W FEE SCHEDULE Mi ��3 �t (n� Description Qty. I Each I Total lNew residential single-or multi-family dwelling unit. Subdivision: 0,\ y-\,vv.,1 ft„.4„,\4, Lot#: S Includes attached garage. 1,000 sq.ft.or less j 168.54 4 Tax map/parcel#: Ea.add'1500 sq.ft.or portion s 33.92 1 DESCRIPTION OF WORK Limited energy,residential (',r, (with above sq.ft.) 75.00 2 Limited energy,multi-family 75.00 2 residential(with above sq.ft.) [PROPERTY OWNERRenewable Energy 0 See Page 2 I 0TENANT Services or feeders installation,alteration,and/or relocation Name: Q l U(k(` 1 J / / Cj200 amps or less 100.70 2 z f' 201 amps to 400 amps 133.56 2 - Address: ``-'\1\`h N1.J V tt�j ay..), tl� Liv Pv .15.7-c 1 401 amps to 600 amps 200.34 2 City/State/ZIP: c,kiut, .4,--1 0 ? CA-1-0Db 601 amps to 1,000 amps 301.04 2 Phone:(cr)) v p� ( ). ' Fax: Over 1,000 amps or volts 552.26 2 , L ` Temporary services or feeders installation,alteration,and/or Email: (\yl+> �J & y----\k..\)(n,c j AAA y1,4., ,(4 '—' relocation Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 1 intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2 Owner signature: Date: 401 amps to 599 amps 168.54 2 APPLICANT 0 CONTACT PERSON lik Branch circuits—new,alteration,or extension,per panel A.Fee for branch circuits with Business name: .,,\;, ("',Z,. t11/t)it ti above service or feeder fee, 7 42 2 each branch circuit Contact name: B.Fee for branch circuits without Address: service or feeder fee,first 56.18 2 branch circuit City/State/ZIP: Each add'l branch circuit 7.42 2 Miscellaneous(service or feeder not included) Phone:( ) Fax: :( ) Each manufactured or modular dwelling,service and/or feeder 67.84 2 Email: Reconnect only 67.84 2 CONTRACTOR Pump or irrigation circle 67.84 2 Business name: �S ,�.v\,w i'-_, tt ,-v Sign or outline lighting 67.84 2 Address: l L Signal circuit(s)or limited-energy panel,alteration,or extension. 0 See Page 2 2 City/State/ZIP: Each additional inspection over allowable in any of the above Additional inspection(1 hr min) 66.25/hr Phone:( ) Fax:( ) Investigation(1 hr min) 90.00/hr Email: Industrial plant(1 hr min) 78.18/hr Inspections for which no fee is 90.00/hr CCB Lic.: Electrical Lic.: Suprv.Lic.: specifically listed('A hr min) ELECTRICAL PERMIT FEES Suprv.Electrician signature,required: Subtotal: Print name: Date: 0 Plan Review Required(25%of permit fee): State surcharge(12%of permit fee): n Authorized signature: / TOTAL PERMIT FEE: ]� This permit application expires if a permit is not obtained within 180 Print name: `J r 1 Date: I/1 Y/Li days after it has been accepted as complete. [[ * Number of inspections allowed per permit. 1:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/015 440-4615T(l I/05/COM/WEB 1 Electrical Permit Application—City of Tigard Page 2—Supplemental Information Limited Energy Permit Fees: Renewable Energy Permit Fees: RESIDENTIAL WORK ONLY: FEE SCHEDULE Description Qty. Each I Total I * Fee for all residential systems combined: $75.00 Renewable electrical energy systems: Check Type of Work Involved: 5 kva or less 100.70 2 5.01 to 15 kva 133.56 2 ❑ Audio and Stereo Systems* 15.01 to 25 kva 200.34 2 Wind generation systems in excess of 25 kva: ❑ Burglar Alarm 25.01 to 50 kva 301.04 2 50.01 to 100 kva 552.26 2 ❑ Garage Door Opener* >100 kva(fee in accordance with OAR 918-309-0040) 552.26 2 ❑ Heating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva: System* Each additional kva over 25 7.42 3 ❑ Vacuum Systems* >100 kva—no additional charge 0.0 3 Each additional inspection over allowable in any of the above: ❑ Other: Each additional inspection is 66.25/hr 1 charged at an hourly(1 hr min) Inspections for which no fee is 90.00/hr specifically listed('h hr min) v >' PERMIT FEES,, ?< CC�I�IMERCIAL;WORK ONLY: .; ELECTRICAL Subtotal(Enter on Page 1): Fee for each commercial system: $75.00 * Number of inspections allowed per permit. (SEE OAR 918-309-0000) Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation n Fire Alarm Installation ❑ HVAC ❑ Instrumentation ❑ Intercom and Paging Systems n Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* n Protective Signaling ❑ Other: Total number of commercial systems: *No licenses are required. Licenses are required for all other installations I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 Plumbing Permit Application J '� j Building Fixtures FOR OFFICE ISE ONLv • City of Tigard 2 0 2016 Received permit No.: 13125 SW Hall Blvd.,Tigard,OR 97223 OCTU Date/By: /hST; j�/v_Doi 3,3 = Plan Review Phone: 503.718.2439 Fax: 503.598.1 s Other Permit No.: Inspection Line: 503.639.4175Jr I` Date/By: _ Internet: www.tigard-or.gov BUILDINGDIVISIO gat tifiee Rd/Methady/Bo Juris: Supplemental See Page 2 fnr ik fJ T t thod: Information TIGARD TYPE OF WORK FEE* SCHEDULE KNew construction 0 Demolition For special information use checklist Description Qty. Ea. Total ❑Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) CATEGORY OF CONSTRUCTION SFR(1)bath 312.70 t 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78 SFR(3)bath 500.32 ❑Accessory building 0 Multi-family Each additional bath/kitchen 25.02 ❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: Job site address: k--tt u-j c�w 1'7''12�� Catch basin or area drain 18.76 Drywell,leach line,or trench drain 18.76 City/State/ZIP: "C 1 '1\L�� ,f Cl (`l j Footing drain(no.linear ft.:_) Page 2 Suite/bldg./apt.no.: J Project name: C\ l 4_ 1i,VW," Manufactured home utilities 50.03 Cross street/directions to job site: C t.J ,N t V Manholes 18.76 �) ,4\ NA)-E., Rain drain connector 18.76 11 Sanitary sewer(no.linear ft.: ) Page 2 Storm sewer(no.linear ft.:_) Page 2 Water service(no.linear ft.:_) Page 2 Subdivision: c( ),,\,,, -,. ,_ky, Lot no.: Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 DESCRIPTION OF WORKBackwater valve 12.51 Clothes washer 25.02 ' x/ -, e, -Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 PROPERTYU 7'. � Yw, 1 ��v„�t/�7 WNEI..: � ,` = ] TENANTExpansion tank 12.51 Name: CFixture/sewer cap 25.02 1 � �.: , Address: I x- -51 �,-1 Floor oordrain/floor sink/hub 25.02 \� C N L � 13 v >cEv) Pe i(4-6'vi 5 - Garbage disposal 25.02 City/State/ZIP: 0yic v -, 0 y C\"11 JO Hose bib 25.02 Phone:(0017) ( 5- JC( ) V Fax ( ) Ice maker 12.51 APPLICANT/',.:'''' C ?CONTAC'T PERSON Interceptor/grease trap 25.02 Business name: GA;i�'vv, (r,ij ( j(.�-2- Medical gas(value:$ ) Page 2 Primer 12.51 Contact name: Roof drain(commercial) 12.51 Address: Sink/basin/lavatory 25.02 City/State/ZIP: Solar units(potable water) 62.54 Phone:( ) Fax::( ) Tub/shower/shower pan 12.51 E-mail: Urinal 25.02 _. Water closet 25.02 CO CTOR Water heater 37.52 Business name: ,..,--- t,� ��'y)----)6,1Ly�t I,\, Waterpip in DWV 56.29 Address: Other: 25.02 City/State/ZIP: Subtotal Phone:( ) Fax:( ) Minimum permit fee: $72.50 CCB Lic.: Plumbing Lic.no.: Plan review (25%of permit fee) /� State surcharge(12%of permit fee) Authorized signature: 2i } TOTAL PERMIT FEE Print name: Q 'rZ �'/ - 1„.19,/,/ Date: //�1_/si/ This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. *Fee methodology set by Tri-County Building Industry Service Board. 1:\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB) Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information • Fee Schedule: Residential Fire Suppression Systems: Site Utilities Qty. Fee(ea) Total Square Footage: Permit Fee: Footing drain-1 s`100' 50.03 0 to 2,000 $121.90 Footing drain-each additional 100' 37.52 2,001 to 3,600 $169.69 3,601 to 7,200 $233.20 Sewer-1st 100' 62.54 7,201 and greater $327.54 Sewer-each additional 100' 37.52 Water Service-1st 100' 62.54 Medical Gas Systems: Water Service-each additional 100' 37.52 Valuation: Permit Fee: Storm&Rain Drain-Ist 100' 62.54 $1.00 to$5,000.00 Minimum fee$72.50 Storm&Rain Drain-each additional 100' 37.52 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for Qt ' Fee(ea) Total each additional$100.00 or fraction thereof,to Other Inspectionsy.or Fees and including$10,000.00. Inspection of existing plumbing or for $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and$1.54 for which no fee is specifically indicated 90.00/hr each additional$100.00 or fraction thereof,to (minimum charge-1/2 hour) and including$25,000.00. Inspections outside of normal business 90.00/hr $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and$1.45 for hours(minimum charge-2 hours) each additional$100.00 or fraction thereof,to Reinspection Fees 90.00/hr and including$50,000.00. Additional plan review for revisions 90.00/hr $50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for (minimum charge 1/2 hour) each additional$100.00 or fraction thereof. Subtotal: Commercial Fixture Work: Are you capping,adding or replacing fixtures? If"yes", please indicate work performed by fixture. Failure to accurately report fixtures could result in increased sewer fees*. Plan Review for Plumbing Installations Quantity by Fixture Type Plan review is required for any of the following. Fixture Type for Rept/ Please check all that apply. Work Performed: Capped Added Relocate 0 Any new commercial building with water service 2"and Baptistry/Font -Tub/Shower greater,except systems designed and stamped by licensed Bath: engineer. -Jacuzzi/Whirlpool Car Wash: Each Stall 0 New exterior plumbing site utilities for any complex structure Drive tall as defined in OAR918-780-0040. Cuspidor/Water Aspirator 0 Medical gas and vacuum systems for health care facilities. Dishwasher: Commercial 0 Any multipurpose fire sprinkler system. Domestic ❑ Any complex structure as defined in OAR918-780-0040. Drinking Fountain Eye Wash Submit 2 sets of plans with any of the above. Floor Drain/sink: -2" 3" Isometric or Riser Diagram 4" 0 Isometric or riser diagram is required for new buildings -Car Wash Drain Garbage Domestic non-food that meet the qualifications above. Disposal: -Domestic food related -Commercial food related -Industrial food related Ice Mach./Refrig.Drains Comments regarding fixture work: Oil Separator(Gas Station) Rec.Vehicle Dump Station Shower: -Gang -Stall Sink: -lav/Bar non-food related -Bradley -Com/Serv/Util food related -Service *Note: If the fixture work under this permit results in an Swimming Pool Filter increase of sewer EDUs,a sewer permit will be issued and Washer-Clothes fees assessed for the sewer increase must be paid before the Water Extractor Water Closet-Toilet plumbing permit can be issued. Urinal Other Fixtures: I:\Building\Permits\PLMF PermitApp.doc 08/04/2011 2 City of Tigard ilh c e " COMMUNITY DEVELOPMENT DEPARTMENT T 1 G A R D Building Permit Review — Residential Building Permit #: .7)237?) /6.- Ovit 33 Site Address: 12 g G3 ss 1.33 ( U v-c. Project Name: (iv Cn I n u 4- ri d a , Lot #: S (New dwelling=subdivision name;Addition or Alteration=last name of owner) Planning Review Proposal: N J OVerify site address/suite#exists and active in permit system. L'1 River Terrace Neighborhood: No El Yes,See River Terrace Review Addendum Attached Site Plan Elements: JA Three(3)copies of site plan 'Existing structures on site OSite plan must be on 8-1/2"x 11"or 11 x 17"paper ,Footprint of new structure(including decks)with finished Drawn to scale(standard architect or engineer scale) floor elevations North arrow Utility locations(required for new,may apply for additions) iz-Site address,project or subdivision name and lot number 9.Lecation of wells/septic systems Applicant information(name and phone number) ,VExisting trees to be retained with drip line,and tree ,lLot dimensions and building setback dimensions protectiondrip line,ZI-La area,building coverage area,percentage of coverage and ,Street tree size,type and location impervious area(applicable if R-7,R-12,R-25&R-40) Street names 'Property corner elevations(2 foot contour lines if more than 4 foot differential) 0 Clean Water Services—Service Provider Letter(lot platted prior to 9/10/1995): Required: ❑ Yes,applicant was notified ❑ No Received: ❑ Yes ❑ No yzr Public Facilities Improvement(PFI) Permit: Required: ❑ Yes,applicant was notified 1:1No Applied For: E Yes ❑ No,stop intake IZI Land Use Case#: S U Q 2-0 (4 - O 0 a ( W Zoning: K zi .---C 0 Required Setbacks: Front VO Rear I S Side 3 Street Side I•S Garage Landscape Requirement: . Lot Coverage Maximum: '.� 0/0 Building Height: Maximum Height 3-0 Actual Height 7 LI Visual Clearance Easements Censitive Lands: ❑ Yes El No Type J2KUrban Forestry Plan Conditions "Met"prior to issuance of building permit Notes: Approved By Planning: '" l 09 w\--� V „,-L Date: 10/2o/it. Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved El Not Approved Revision 3: El Approved ❑ Not Approved I:\Building\Forms\BldgPermitRvw RES 091216.docx Building Permit Submittal Original Submittal Date: hd/C4" Site Plans: # 3 Building Plans: # �_ Building Permit#: nter building pperms #above. Workflow Routing: la ging L�1'r ngineering ermit Coordinator uilding Workflow Sign-off: R."Si ff for Planning(include notes from planning review) Route Application Documents: Engineering: (1) copy of permit application, (1) site plan, (1) building plan and 2.41./..-2111i.. 1 plan review routing form. uldtng: original permit application, site plans,building plans,engineer and beam calculations and trust details,if applicable,etc. Notes: By Permit Technician: ‘„,,,,,.7,...0e—__ Date: Arfi/G Engineering Review Jr Slope at building pad: /2 Z /Conditions "Met"prior to issuance of building permit ❑ Easements (encroachments)per engineering conditions of approval and plat ❑ Water Quality/Quantity Facility: Assess Water Quality Fee in-lieu: ❑ Yes El No Assess Water Quantity Fee in-lieu: El Yes El No LIDA Facility on lot: ❑ Yes ❑ No ❑ NOT Approved by Engineering: Date: Notes: Approved by Engineering: „,4( Date: 10- -lb Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved Revision 3: El Approved El Not Approved Permit Coordinator Review ❑ Conditions"Met"prior to issuance of building permit ❑ Approved,NOT Released: Date: Notes: Revisions (after Building Submittal only) Revision Notice 1: Date Sent to Applicant: Revision Notice 2: Date Sent to Applicant: Revision Notice 3: Date Sent to Applicant: t7c6DC Fees Entered: Wash Co Trans Dev Tax: i'es ❑ N/A Tigard Trans SDC: Yes ❑ N/A Parks SDC: Yes ❑ N/A rOK to Issue Permit pproved by Permit Coordinator: 411-Date: `P '1 Y4,0 I:\Building\Forms\BldgPermitRvw_RES_091216.docx City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT a Request for Permit Action REC;t:IVIM TI G A R D 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • www.tigardRgcs 1 2016 CITY L z 4& TO: CITY OF TIGARD � a Building Division 13125 SW Hall Blvd.,Tigard,OR 97223 Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits@tigard-or.gov FROM: t Owner n Applicant Et Contractor ❑ City Staff Check(✓)one REFUND OR Name: INVOICE TO: (Business or Individual) t V 1.).t L\t; Mailing Address: \ 1023 rl v(vit.) 1 3.1 V City/State/Zip: CL\)k,v v _ D� ��-\) , Ck'1 QC (G 1 Phone No.: S.Loi 5 04000 b fr-V€s6?//liars/daft)c PLEASE TAKE ACTION FOR THE IT (S) CHECKED (1): C• Ali, Cly./VOID PERMIT APPLICATION. r 4 -dr . •Li PERMIT FEES (attach copy of original receipt and provide explanation below). e,= INVOIC OR FEES DUE (attach case fee schedule and provide explanation below). ` • ■ REMOVE/REPLACE CONTRACTOR ON PERMIT (do not cancel permit). Permit#: 'Me) "741kt - 00A-12— Site OA'1Site Address or Parcel#: \ti i-0k,2"3 `,'`u-' lei Ic\ ho)r Subdivision Name: CA ti t)t,, Lot#: EXPLANATTON: - C \ . - c� t\viry �J L ' A, i'v `"1 Y2 put ytt 4- , , , 4- ) ! 115.64 �.� ,� S':,av e: Date: � ,V `-1 �. . \ °z( Z Print Name: \i" A-\ 1`CD LMt, Refund Policy 1. The city's Community Development Director,Building Official or City Engineer may authorize the refund of: • Any fee which was erroneously paid or collected. • Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort has been expended. • Not more than 80%of the application or permit fee for issued permits prior to any inspection requests. 2. All refunds will be returned to the original payer in the form of a check via US postal service. 3. Please allow 3-4 weeks for processing refund requests. 'j cZ� ~ ! /9.-A fr f L/�,cz) 2 , �J _ /6 , f, ' Act FOR OFFICE USE ONLY Route to Sys Admin: Date- 2/ /, By J' Route to Records: Date 7-37— Refund :y Refund Processed: Date ,9-- :y Invoice Processed: Date By Permit Canceled: Date By Parcel Tag Added: Date By I:\Building\Forms\RegPermitAction_092314.doc Dianna Howse From: Dianna Howse Sent: Monday, March 13, 2017 11:38 AM To: bgroves@riversidehome.com Cc: #Building Permit Technicians Subject: MST2016-00433,Walnut Ridge, Lot 5 Hello Brett, On 2/21/2017 this permit was modified and reprinted to remove the laundry tray and (1) hose bib to reduce water meter costs. I have now modified the permit fees for this scope of work change and there is a balance due of$16.98 for administrative fees to change this permit. You can pay the fees online at https://aca.accela.com/tigard/by searching for the permit number,or you can pay in person, Monday-Thursday,8:00 am to 4:30 pm. We are closed on Fridays. Please note that inspections cannot be scheduled until this additional fee is paid. Thank you. Dianna Howse Building Division Services Supervisor City of Tigard I Community Development 13125 SW Hall Blvd.,Tigard, OR 97223 503-718-2430 DISCLAIMER: E-mails sent or received by City of Tigard employees are subject to public record laws. If requested, e-mail may be disclosed to another party unless exempt from disclosure under Oregon Public Records Law. E-mails are retained by the City of Tigard in compliance with the Oregon Administrative Rules"City General Records Retention Schedule." 1 CITY OF TIGARD RECEIPT Il t, 2 . 13125 SW Hall Blvd.,Tigard OR 97223 503.639.4171 TIGARD Receipt Number: 408592 - 01/30/2017 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID MST2016-00433 Building Permit-New Construction 230-0000-43104 $1,972.54 MST2016-00433 Plan Review 230-0000-43106 $1.34 MST2016-00433 12%State Surcharge-Building 100-0000-24001 $236.70 MST2016-00433 Wash Co Trans Dev Tax-SF Detached 405-0000-43320 $8,278.00 MST2016-00433 Tigard Trans SDC Improvement-SF 415-0000-43300 $5,488.00 Detached MST2016-00433 Tigard Trans SDC Reimbursement-SF 415-0000-43301 $317.00 Detached MST2016-00433 Parks SDC Improvement-SF Dwelling 425-0000-43300 $4,356.00 (detached/attached) MST2016-00433 Parks SDC Reimbursement-SF 425-0000-43301 $1,207.00 Dwelling(detached/attached) MST2016-00433 Parks SDC Neighborhood-SF Dwelling 425-0000-43300 $1,615.00 (detached/attached) MST2016-00433 DC Provision Review, SF-Ping 100-0000-43112 $90.00 MST2016-00433 Info Process/Archiving-Lg$2.00(over 230-0000-43135 $28.00 11x17) MST2016-00433 Info Process/Archiving-Sm$0.50(up to 230-0000-43135 $50.50 11x17) MST2016-00433 Metro Const. Excise Tax 230-0000-24010 $419.52 MST2016-00433 Beaverton School CET-Residential 230-0000-24101 $3,567.00 MST2016-00433 Permit Fee-Elect(per dwelling unit) 220-0000-43103 $338.14 M5T2016-00433 Limited Energy 220-0000-43103 $75.00 MST2016-00433 12%State Surcharge-Electrical 100-0000-24001 $49.58 MST2016-00433 Furnaces< 100K BTU 230-0000-43102 $46.75 MST2016-00433 Water Heater 230-0000-43102 $23.32 MST2016-00433 Gas Fireplace 230-0000-43102 $33.39 MST2016-00433 Range Hood/Other Kitchen 230-0000-43102 $33.39 MST2016-00433 Clothes Dryer Exhaust 230-0000-43102 $33.39 MST2016-00433__ Single Duct Exhaust(Bathrooms,Toilet, 230-0000-43102 $116.60 Utility Rooms) MST2016-00433 Fuel Piping 230-0000-43102 $14.15 MST2016-00433 12%State Surcharge-Mechanical 100-0000-24001 $36.12 MST2016-00433 SFR-Baths 230-0000-43101 $500.32 MST2016-00433 Erosion Control w/Development 100-0000-43134 $386.40 MST2016-00433 Plan Review 230-0000-43106 $530.81 MST2016-00433 Fire Sprinkler 230-0000-43101 $169.60 MST2016-00433 12%State Surcharge-Plumbing 100-0000-24001 $80.39 MST2016-00433 Misc Administration Fee 230-0000-45319 $28.02 Total: $30,121.97 PAYMENT METHOD CHECK# CC AUTH.CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Check 35624 BTAGGART 01/30/2017 $30,121.97 Payor: Riverside Homes LLC Total Payments: $30,121.97 Balance Due: $16.98 Page 1 of 1 CITY OF TIGARD RECEIPT t , 13125 SW Hall Blvd.,Tigard OR 97223 503.639.4171 TIGARD Receipt Number: 408592 - 01/30/2017 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID MST2016-00433 Building Permit-New Construction 230-0000-43104 $1,972.54 MST2016-00433 Plan Review 230-0000-43106 $1.34 MST2016-00433 12%State Surcharge-Building 100-0000-24001 $236.70 MST2016-00433 Wash Co Trans Dev Tax-SF Detached 405-0000-43320 $8,278.00 MST2016-00433 Tigard Trans SDC Improvement-SF 415-0000-43300 $5,488.00 Detached MST2016-00433 Tigard Trans SDC Reimbursement-SF 415-0000-43301 $317.00 Detached MST2016-00433 Parks SDC Improvement-SF Dwelling 425-0000-43300 $4,356.00 (detached/attached) MST2016-00433 Parks SDC Reimbursement-SF 425-0000-43301 $1,207.00 Dwelling(detached/attached) MST2016-00433 Parks SDC Neighborhood-SF Dwelling 425-0000-43300 $1,615.00 (detached/attached) MST2016-00433 DC Provision Review, SF-Ping 100-0000-43112 $90.00 MST2016-00433 Info Process/Archiving-Lg$2.00(over 230-0000-43135 $28.00 11x17) MST2016-00433 Info Process/Archiving-Sm$0.50(up to 230-0000-43135 $50.50 11x17) MST2016-00433 Metro Const. Excise Tax 230-0000-24010 $419.52 MST2016-00433 Beaverton School CET-Residential 230-0000-24101 $3,567.00 MST2016-00433 Permit Fee-Elect(per dwelling unit) 220-0000-43103 $338.14 MST2016-00433 Limited Energy 220-0000-43103 $75.00 MST2016-00433 12%State Surcharge-Electrical 100-0000-24001 $49.58 MST2016-00433 Furnaces< 100K BTU 230-0000-43102 $46.75 MST2016-00433 Water Heater 230-0000-43102 $23.32 MST2016-00433 Gas Fireplace 230-0000-43102 $33.39 MST2016-00433 Range Hood/Other Kitchen 230-0000-43102 $33.39 MST2016-00433 Clothes Dryer Exhaust 230-0000-43102 $33.39 MST2016-00433 Single Duct Exhaust(Bathrooms,Toilet, 230-0000-43102 $116.60 Utility Rooms) MST2016-00433 Fuel Piping 230-0000-43102 $14.15 MST2016-00433 12%State Surcharge-Mechanical 100-0000-24001 $36.12 MST2016-00433 SFR-Baths 230-0000-43101 $500.32 M5T2016-00433 Laundry Tray 230-0000-43101 $25.02 E-- MST2016-00433 12%State Surcharge-Plumbing 100-0000-24001 $83.39 4— MST2016-00433 Erosion Control w/Development 100-0000-43134 $386.40 MST2016-00433 Plan Review 230-0000-43106 $530.81 MST2016-00433 Fire Sprinkler 230-0000-43101 $169.60 Total: $30,121.97 PAYMENT METHOD CHECK# CC AUTH.CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Check 35624 BTAGGART 01/30/2017 $30,121.97 Payor: Riverside Homes LLC Total Payments: $30,121.97 Balance Due: $0.00 Page 1 of 1 _ CITY OF TIGARD MASTER PERMIT ` a I . III I' COMMUNITY DEVELOPMENT Wog/MI11 Permit#: MST2016-00433 13125 SW Hall Blvd.,Ti Date Issued: 01/30/2017 • TICAI' I and OR 97223 503.718.2439 9 Parcel: 2S 104AC 15100 Jurisdiction: Tigard Site address: 12863 SW 133RD AVE_ Subdivision: WALNUT RIDGE Lot: 5 Project: Walnut Ridge, Lot 5 Project Description: New SF.2/21/17, REPRINTED to remove(1)hose bib&(1)laundry tray. BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 5 First: 1367 sf Basement: 0 sf Left: 5 Parking Spaces: 0 Height 26 Bathrooms: 3 Second: 1533 sf Garage: 491 sf Front: 20 Smoke Dwelling Units: 1 Third: 0 sf Right: 5 Detectors: Yes Total: 2900 sf Value: $349,602.73 Rear: 15 PLUMBING Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 1 Urinals: 0 Lavatories: 4 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Storm Sewer: 100 Drains: 0 Tubs/Showers: 4 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Catch Basins: 0 Bckflw Prevntr: 0 Footing Drain: 0 Ice Maker: 1 Hose Bib: 1 Backwater Value: 1 Drywell-Trench Drain: 0 Other Fixtures: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 5 Clothes Dryers: 1 Natural Gas Heat Pump: N Hoods: 1 Other Units: 0 Furn<100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 4 Fum>=100K: 0 ELECTRICAL Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits 1000 sf or less: 1 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0 Ea add'I 500 sf: 5 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 0 Mfd Home/Feeder/Svc: 0 401-600 amp: 0 401-600 amp: 0 601-1000 amp: 0 601+amp-1000v: 0 1000+amp/volt: 0 ELECTRICAL-RESTRICTED ENERGY SF Residential Audio&Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All Other. W. -0lirer+._._ ,:..,.: .. Y BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: NEW SF VB R-3 2900 Owner: Contractor: RIVERSIDE HOMES LLC RIVERSIDE HOMES LLC Required Items and Reports(Conditions) 17933 NW EVERGREEN PKWY, 17933 NW EVERGREEN PKWY 370 1 Ersn Cntrl 503-639-4175 #370 BEAVERTON,OR 97006 BEAVERTON,OR 97006 PHONE: PHONE: 503-645-0986 FAX: 503-690-2942 Total Fees: $30,871.97 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTEN •,• Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-is 0 through•'R 952-0.1-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issue. By: 4 • ' /,%L4 —,_ Permittee Signat e�//(T-e LL.Z Call 503.639.4175 by 7:00 a.m.for the next available inspection�d . `1 This permit card shall be kept in a conspicuous place on the job site until corfipletion of the project. Approved plans are required on the job site at the time of each inspection. Mechanical Permit Application 101z()Ft 1(T l SE o\LV City of Tigard Received PermitNo.: picr-rpiL 71 13125 SW Hall Blvd.,Tigard,OR 97223. PlanRe Date/By: `•J J[ oSiJ Plan Review Phone: 503.718.2439 Fax: 503.598.196 } Other Permit: �A FI : ,A DateBy: -1-I G A R D Inspection Line: 503.639.4175 Date Ready/By: Juris: ® See Page 2 for Internet: www.tigard-or.gov Notified/Method: Supplemental Information OCT 2a7a1s TYPE OF WORK COMMERCIAL FEE* SCHEDULE -7,USE CHECKLIST ( e r la 44 D Mechanical permit fees*are based on the value of the work Alew construction ❑Addition/alterat7et4/ lTa {�e�li performed.Indicate the value(rounded to the nearest dollar)of all 0 Demolition El Other: BUILDING DIVISION mechanical materials,equipment,labor,overhead,and profit. Value:$ CATEGORY OF CONSTRUCTION � �,1 I b 'lF RESIDENTIAL EQULPMENT/SYSTEMS FEES* "C-and 2-family dwelling 0 Commercial/indus to TJ ,;:' 'sory bui •ing For special information use checklist gr ❑Multi-family ❑Master builder ■ Other Description Qty. Ea. Total JOB SITE INFORMATION AND i t SON Heating/cooling: r Air conditioning 46.75 Job site address: 't'L t) ki � 7 t—IP) 11\ '`)G Furnace 100,000 BTU(ducts/vents) 46.75 City/State/ZIP: T i5l�rN D-. rl'1.t.1".� Furnace 100,000+BTU(ducts/vents) 54.91 Suite/bldg./apt.no.: Project name: t(\1 y\L.\ - IC-t PG L Heat pump 61.06 Duct work 23.32 Cross street/directions to job site: 'jV; ' v\i/4 c'l--)t Hydronic hot water system 23.32 <, V .1'1;1) ,�,�rZ\ v C f Residential boiler(radiator or hydronic) 23.32 Unit heaters(fuel-type,not electric), in-wall,in-duct,suspended,etc. 46.75 • Flue/vent for any of above 23.32 Subdivision: \i..\,INA yl N'‘.•"\ V VA)tL Lot no.: 5'� �Oth ' 23.32 J Other fuel appliances: Tax map/parcel no.: Water heater 23.32 h DEsoarrIO1!t,of WORD..`1,:4'=• ,,=' Gas fireplac/insert 33.39 •,. ., ,mss,. � r' Flue vent for water heater or gas n L\,J tD T f C�J"`4i ANAA, �� fireplace 23.32 Log lighter(gas) 23.32 Wood/pellet stove 33.39 Wood fireplace/insert 23.32 Chimney/liner/flue/vent 23.32 Other 23.32 OPE '3lcOWNER Q TENANT l - Environmental exhaust and ventilation: Name: \ VC-V9 LP l l,I,�I I,`,NL-h L{ Range hood/other kitchen i'J, � '^ ((' equipment 33.39 Address: VI(1\ ")-. V) "e,6\)1,4-4 1 .• Pt,�I`1ni/i17L , ��Alothesdryerexhaust 33.39 City/State/ZIP: c2j/'1,6\i�,y,i ;-, c)n 01)6 i Single-duct exhaust(bathrooms, _ V toilet compartments,utility rooms) 23.32 Phone:(rjL"5) �:t-1 C , C r, Fax:( ) Attic/crawlspace fans 23.32 IAA. 1.ICANT „„ .0 CONTACT PERSON "' Other: 23.32 _ FuelP i io P g: Business name: 5C,,tai t, cV.2' A' $14.15 for first four;$4.03 for each additional Contact name: Furnace,etc. Address: Gas heat pump Wall/suspended/unit heater I City/State/ZIP: Water heater Phone:( ) Fax::( ) Fireplace Range E-mail: Barbecue ': CONTRACTOR,: Clothes dryer(gas) , Other Business name. \A rk-- N•tA,^ ��1 � , c- �') l u`� MECHANICAL PERMIT FEES* ' Address: 1 't Air ra_fax [s Subtotal 1 Ci /State/ZIP: G ,gA„ei //�/� ) Minimum permit fee($90.00) City/State/DEP: �� / i ' � �t/`-' Plan review(25%of permit fee) Phone:(5,; ) '71j—3t,-7•) Fax:( ) State surcharge(12%of permit fee) CCB lie.: 51 3 3:),.... �C TOTAL PERMIT FEE w . This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Authorized signature: l * Fee methodology set by Tri-County Building Industry Service Board Print name: Date: I:\Building\Permits\MEC_PermitApp_040113.doc 440-4617T(11/02/COM/WEB) I Plumbing Permit ApplicationE � '� j�} Building Fixtures �►=' FOR OFFICE. Ise ON LN • City of Tigard2 Q ReECW OCT No.:13125 SW Hall Blvd.,Tigard,OR 97223 Phone: 503.718.2439 Fax: 503.598.1p6( F g/ y: Other Permit No.: Inspection Line: 503.639.4175 �,I.try d'1` Date/B T I G A R D Date Ready/By: kris: BJ See Page 2 for Internet: www.tigard-or.gov �y (9 tlj� DI 1S(O otified/Method: supplemental information TYPE OF WORK FEE* SCHEDULE KNew construction 0 Demolition For special information use checklist Description Qty. I Ea. 1 Total 0 Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) CATEGORY OF CONSTRUCTION l SFR(I)bath 312.70 -'\-and 2-family dwelling 0 Comme t4 . ,u. SFR(2)bath 437.78 D �+ SFR(3)bath 500.32 0 Accessory building 0 Multi-fa Each additional bath/kitchen 25.02 ❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: _ Job site address: kli u j 5W 1"TIj 4 i Catch basin or area drain 18.76 Dryvvell,leach line ortrench drain 18.76 City/State/ZIP: A t ti &.✓4 h, Cl--)-m'7 Footing drain(no.linear ft.:_) Page 2 Suite/bldg./apt.no.: Project name: C:l i,�4_ a 111// Manufactured home utilities 50.03 Cross street/directions to job site: (Skis) kA)r 1 1,vv,, ,' C. L"-) Manholes 18.76 \-J ✓t\ (T t, Rain drain connector 18.76 Sanitary sewer(no.linear ft.: ) Page 2 Storm sewer(no.linear ft.: ) Page 2 Water service(no.linear ft.: ) Page 2 Subdivision: �v A C rte; (Z.-'..It j , I Lot no.: c Fixture or item: Tax map/parcel no.: �T' Backflow preventer 31.27 Backwater valve 12.51 •', AESCRIPTION OF`_t►'VORK L N Clothes washer 25.02 r� cL-- Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 PROPERTY QWNER„ 0 TE1'ANT Expansion tank 12.51 Name: \J.1 jS r C, Fixture/sewer cap 25.02 1 1-1--------{ Floor drain/floor sink/hub 25.02 Address: \'m(\Ci t5 ` I,W L,,V ti, 1.(.C/� ev„t((;(,-&V/ -151 Garbage disposal 25.02 City/State/ZIP: ,0VC"'trk v\ 0y- `n, i'1 t JO Hose bib 25.02 Phone:6T2 ) I (3c(() Fax ( ) Ice maker 12.51 APPLICANT. i' C].i'CONTACi'4ERSON' Interceptor/grease trap 25.02 Business name: G6\., „ cL,5 i:�- Medical gas(value:$ ) Page 2 Primer 12.51 Contact name: Roof drain(commercial) 12.51 Address: Sink/basin/lavatory 25.02 City/State/ZIP: Solar units(potable water) 62.54 Phone:( ) Fax::( ) Tub/shower/shower pan 12.51 E-mail: Urinal 25.02 CO CTO1 Water closet 25.02 Water heater 37.52 Business name: �,t--�,(. 1 I�/�r 1a*!L,k-yl 1 '�� Waterpiping/Dwv 56.29 Address: 575.7 ,s-a. i4J,i/ev.i 4'i Other: 25.02 City/State/ZIP: /11,/ 4 .,4 IL 0 ' q?A 7 Subtotal 5-_ q 6-7 s Fax:( ) Minimum permit fee: $72.50 Phone:(2 3) tl7 CCB Lic.: ,-764A l Plu bing Lic.no.: A 1t Plan review (25%of permit fee) �2 / State surcharge(12%ofperPERMITmit fee) Authorized signature: /) j TOTAL FEE Print name: ,-7 a �� Date: J`J Phi Tbis permit application expires If a permit is not obtained within 180 days after It has been accepted as complete. *Fee methodology set by Tri-County Building Industry Service Board. I:\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB) Electrical Permit Application RECEIVEttot fit 1It°I t ,,t tl`R1 5 14 City of Tigard . `? ...1 "'a 13125 SW Hall Blvd.,Tigard,OR 97223 P Permit#:review lern711714a-0.0,933 Phone: 503.715.2439 Fax: 503.598,1960p o�gy; Related Permit#: 1,11''E i l t Inspection Line: 503.639.4175 OCT 2 0 2 016 Ready Doc/By: heir RI See Page 2 for Internet: www.tigard-or.gov Notified/Method: _ Supplemental Information TYPE OF woR1CITY OFTIGAR ` New construction ®AdditionJalterat Please check all that apply(submit 2 sets of plans w/items checked): 1 "" � � "�01` 0 Service or feeder 400 amps or more 0 Building over three stories. Demolition 0 Other: ' where the available fault current ❑Marinas and boatyards. CATEGORY OF CONSTRU kik, % ' exceeds 10,000 amps at 150 volts or ❑floating buildings. 'ip 1-and 2-family dwelling Commercial/inti ti4 :.' gory b siding leo to ground,or exceeds 14,000 0 Commercial-use agricultural 0 Multi-family ❑Master builder ' I I Oth ❑amps for all other installations.. binstaings. Fire pump. ❑Iastaltation of 150 KVA or JO :SITE INFORMATION. I L s. ON • 1:1EntergencY system killer separately derived }_ A ❑Addition of new motor load of system. Job#: Job site address: 1.1,1V 6-5 5‘....;5‘....; ‘-" S` ` )5/})E 100liP or more, ❑"A""E" "1.2""1-3", City/State/ZIP: ""� %h r 0" •l V 0 Six or more residential units. may. ❑Health-care thcrlities. 0 Recreational vehicle parks. Suite/bIdg./apt.#: Project name: J Allava). it it\ ❑Hazardous locations. ❑supply voltage for more than ❑Service or*oder 600 amps or more. 600 volts nominal. Cross street/directions to job site: 51.E U Al ✓N VL e C.�'t� FEE SCHFAIJILE ‘:"1,3 lk r`t) • _ New residentialTotal l single-or multi faanlly dwelling unit. Subdivision: T;\ ),.\,k,„\ m Lot#: ty Includes attached garage. Tax map/parcei#: 1,000 sq.ftor less 1 168.54 4 Ea.add'l 500 sq.ft.or portion y 33.92 1 /�DFy aellP'FION OF WORK. Limited energy, E l.- 1w residential j 75.00 2 (with above sq.ft.) r Limited energy,multi-family 75.00 2 residential(with above sq.It) aPROPI 'I'Y..OWNER N TENANT , S Renewable or feedersne Page2 rev ❑ See(� t t - Services or i tapation�dteration,and/or relocation Name: ?..-‘v CX 41„, rU 1 1 rfv.c, i ,L....6„. 200 amps or less 100.70 r 2 c 201 amps to 400 amps 133.56 2 - Address: \--\1\17-5 ti I::: til 3 '1 I`"' t�' .' z' `401 amps to 600 amps 200.34 2 City/State/ZIP: L14,rlA,' ..)‘n ® y- CI (},b 601 amps to 1,000 amps 30104 r 2 Phone:( ) (c`t S' Ott(,IS i, Fax:( ) Over 1,000 amps or volts 552.26 2 ICA Temporary enrolees or feeders Installation,alteration,and/or Email: ii Yllf L 0. n vI4, AAA v‘,..1,.4 y— relocation Owner install on:This installation is being made on property that I own which is not 200 amps or leas 59.36 1 intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 1 2 Owner signature: Date: 401 amps to 599 amps I i 168.54 2 ; . '' Branch circuits— alteration,or extension, er panel _ new,ttPIICxff CONTACT PARSON p A.Fee for branch circuits with Business name: + n,t.,4,, Anil,q. above service or feeder fee, 7.42 2 each branch circuit Contact name: B.Fee for branch circuits without Address: service or feeder "first 56.18 2 branch circuit City/State/ZIP: Each addl branch circuit 7.42 2 Miscellaneous(service or feeder not included) Phone:( ) Fax::( ) Each manufactured or modular 67.84 2 Email: dwelling,service and/or feeder Reconnect only 67.84 2 67.84 2 Business name: .IUVv lrN.ti/ (COhli<1�AC![O Pump or irrigation circ a 1 ��lli 1.41/ 1 r Sign or outline lighting 67.84 2 Signal circuits)or limited-energy Address: 0141,26 a. ">i'9 '(Aat )-e , panel,alteration,or extension. ❑ See Page 2 2 Each additional inspection over allowable In any of the above City/State/ZIP: 04S;41,46,0 ?0,73sAdditional inspection(1 hr min) 66.25/hr T Phone:( 3 ) -?41231- Fax:( ) investigation(I htmin) 90.00/hr Email: Industrial plant(1 hr min) 78.18/hr Inspections for which no fee is 90.00/br CCB Lic.: /62,1 Electrical Lic.: Suprv.Lic.: 3 7615 specifically listed ehhrmin) ELECTRICAL PERMIT FEES Suprv.Electrician signature,required: adtze Subtotal: Print name: Date: 0 Plan Review Required(25%of permit fee): State surcharge(12%of permit fee): Authorized signature: TOTAL PERMIT FEE: ,` /` This penult appilcatioa expires If a permit is not obtained within 180 Print name: CS s-i,4-t Date: 1 it I/l4 days after It km bean accepted as complete. tt • Number of faapections allowed per permit. k\8uilding\Pumits\Er.0 PamitApp BLR_ERE.doe Rev 06/17 15 440-4615T(l IIDSJCOM/WFB City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 12863 SW 133RD AVE, TIGARD, OR, 97223 Record Type: Record ID: Residential - Master Permit MST2016-00433 Inspection Type: Inspector: 199 Electrical final Chip Barnett Result: PASS Comments: Violation Summary: Inspector Contractor City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 12863 SW 133RD AVE, TIGARD, OR, 97223 Record Type: Record ID: Residential - Master Permit MST2016-00433 Inspection Type: Inspector: 399 Plumbing final Chip Barnett Result: PASS Comments: Violation Summary: Inspector Contractor City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 12863 SW 133RD AVE, TIGARD, OR, 97223 Record Type: Record ID: Residential - Master Permit MST2016-00433 Inspection Type: Inspector: 699 Mechanical final Chip Barnett Result: PASS Comments: Note: No A/C installed at this time Violation Summary: Inspector Contractor